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What Does The MRI Scan Images Indicate?
Question: I simply want to know if an MRI after having injection in the spine will show up where the fluid was placed, the injection where only a few days ago.
Brief Answer:
Needle track is seen only on first day, complications might be seen later
Detailed Answer:
Hi XXXX,
Thanks for writing in to us.
I have read through your query in detail.
Please find my observations below.
1. When MRI is done on same day or within a day after epidural injections, then the needle track and little air in the injection might be visible in most patients. The fluid injected is rapidly absorbed and will not be seen if done in the right way.
2. The fluid gets infused in epidural space and tracks along the nerve to cause reduced sensation of pain and provides pain relief to the nerves blow that level.
3. If there is a complication like a bleed or infection in the area of the epidural injection then it will show up on a repeat MRI done few days later.
4. If there is no complication then nothing new will be seen in the repeat MRI.
5. It cannot be verified if the needle reached its intended target or not if few days are over after taking the epidural shots unless there is a complication like bleeding or infection in the injected area.
Hope this answers your question. Please feel free to correct any oversight in my interpretation of your problems and discuss them in detail as per your requirements.
Hope your query is answered.
Do write back if you have any doubts.
Regards,
Dr.Vivek
Needle track is seen only on first day, complications might be seen later
Detailed Answer:
Hi XXXX,
Thanks for writing in to us.
I have read through your query in detail.
Please find my observations below.
1. When MRI is done on same day or within a day after epidural injections, then the needle track and little air in the injection might be visible in most patients. The fluid injected is rapidly absorbed and will not be seen if done in the right way.
2. The fluid gets infused in epidural space and tracks along the nerve to cause reduced sensation of pain and provides pain relief to the nerves blow that level.
3. If there is a complication like a bleed or infection in the area of the epidural injection then it will show up on a repeat MRI done few days later.
4. If there is no complication then nothing new will be seen in the repeat MRI.
5. It cannot be verified if the needle reached its intended target or not if few days are over after taking the epidural shots unless there is a complication like bleeding or infection in the injected area.
Hope this answers your question. Please feel free to correct any oversight in my interpretation of your problems and discuss them in detail as per your requirements.
Hope your query is answered.
Do write back if you have any doubts.
Regards,
Dr.Vivek
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
If I can send you the slides from my previous MRIs and the symptoms would you in a position to give your opinion? May I ask what your specialty is? After 2 years of trying I do feel as if I'm being palmed off with the bare minimum, and that more could be done to find a more permanent solution to my problems being caused by my back. I am being told that my nerves are not being compromised, when it nips frequently and certain muscles are not responding 'playing paralysed'. There are also cognitive problems, i.e the brain not being able to acknowledge food as fuel, so am permantly chronically fatigued. The first epidural had profound results in that everything switched back on again, muscle response - felt like I sudden had a corset on, boundless energy, sharp memory, but the results only lasted 7-10 days. This latest epidural no response or change to back or cognitive ability. I know in my heart this can be fixed or at least dramatically improved for the long term, but in my present situation, the people I see have appeared not commited to finding a solution, and would love the opinion of anyone outside of the people and situation I am sad to say I find myself in. - Will you try? The more information I have the sooner a solution could be found, very much appreciate your time, will work on copying the slide from the MRIs I have as they may help shed more light on what to try, and where to go next. Thank you.
Brief Answer:
Please upload your old and new MRI images to Dropbox and send me link
Detailed Answer:
Hi XXXX,
Thanks for writing back with an update.
1. I am a specialist physician in diagnostic radiology and read MRI scans. Many people with back and neck problems get their scans done at my hospital each day.
2. Your problem is understandable and I will be glad to view your MRI images. A MRI scan of spine contains about 100 to 200 images in DICOM format which are medical standard images to be seen at the workstation. I have the software and workstation setup at my end. You can upload your raw images (all the files in the MRI CD provided by your hospital) to a file sharing facility like Dropbox and send me the download link. That way I can have a detailed look at all images, including images, other than the ones you have attached.
3. The usual course of treatment for advanced degenerative disc in lumbar spine is the following
(i) Initially physical therapy for few months and mild pain relievers
(ii) Increasing dose of pain relief medications and including specific medications and opioid analgesics.
(iii) Epidural injections
(iv) Facet joint procedures—intraarticular joint steroid injection, medial branch block, and radiofrequency ablation.
(v) Surgery and Disc Interventions
(vi) Spinal Cord Stimulation and Peripheral Nerve Stimulation can be given for persistent pain after disc surgery.
4. Please let me know details of your symptoms and its duration in the past 2 years. You can also upload your old scan images and I can compare any changes between old and new ones.
5. We can discuss more about your solution after viewing the entire series of images just as your doctor in the UK would have done.
Hope your query is answered.
Do write back if you have any doubts.
Regards,
Dr.Vivek
Please upload your old and new MRI images to Dropbox and send me link
Detailed Answer:
Hi XXXX,
Thanks for writing back with an update.
1. I am a specialist physician in diagnostic radiology and read MRI scans. Many people with back and neck problems get their scans done at my hospital each day.
2. Your problem is understandable and I will be glad to view your MRI images. A MRI scan of spine contains about 100 to 200 images in DICOM format which are medical standard images to be seen at the workstation. I have the software and workstation setup at my end. You can upload your raw images (all the files in the MRI CD provided by your hospital) to a file sharing facility like Dropbox and send me the download link. That way I can have a detailed look at all images, including images, other than the ones you have attached.
3. The usual course of treatment for advanced degenerative disc in lumbar spine is the following
(i) Initially physical therapy for few months and mild pain relievers
(ii) Increasing dose of pain relief medications and including specific medications and opioid analgesics.
(iii) Epidural injections
(iv) Facet joint procedures—intraarticular joint steroid injection, medial branch block, and radiofrequency ablation.
(v) Surgery and Disc Interventions
(vi) Spinal Cord Stimulation and Peripheral Nerve Stimulation can be given for persistent pain after disc surgery.
4. Please let me know details of your symptoms and its duration in the past 2 years. You can also upload your old scan images and I can compare any changes between old and new ones.
5. We can discuss more about your solution after viewing the entire series of images just as your doctor in the UK would have done.
Hope your query is answered.
Do write back if you have any doubts.
Regards,
Dr.Vivek
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Do you have an email address as I taken a look at dropbox, and it shows no preferences, and I don't want the images out there for all to see. The system the hospital have used is codonics, which will only let me copy image by image to j.peg. Have put them into file and can send them by email.
Brief Answer:
Please find below the email addresses to which files might be sent
Detailed Answer:
Hi XXXX,
Thanks for writing back with an update.
We understand your desire to send them through email. Please follow the directions mentioned in this reply
1. You can send an email to our customer service at
YYYY@YYYY
and
YYYY@YYYY
Please mention query ID 185281 Kind attention Dr.Vivek Chail and the images will be sent to me.
2. As an alternative you can upload the images to your query but that will be limited to 10 files at a time.
3. In case of any difficulty please do not hesitate to directly contact customer care for help.
Hope your query is answered.
Do write back if you have any doubts.
Regards,
Dr.Vivek
Please find below the email addresses to which files might be sent
Detailed Answer:
Hi XXXX,
Thanks for writing back with an update.
We understand your desire to send them through email. Please follow the directions mentioned in this reply
1. You can send an email to our customer service at
YYYY@YYYY
and
YYYY@YYYY
Please mention query ID 185281 Kind attention Dr.Vivek Chail and the images will be sent to me.
2. As an alternative you can upload the images to your query but that will be limited to 10 files at a time.
3. In case of any difficulty please do not hesitate to directly contact customer care for help.
Hope your query is answered.
Do write back if you have any doubts.
Regards,
Dr.Vivek
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear Doctor,
All the reports are emailed to you please go through, and suggest accordingly.
Thank you for that they are on their way, I left out the localisers. Would love to know your thoughts on the images
All the reports are emailed to you please go through, and suggest accordingly.
Thank you for that they are on their way, I left out the localisers. Would love to know your thoughts on the images
Brief Answer:
You have disc problem at L 4 - L 5 and L 5 - S 1 levels requiring attention
Detailed Answer:
Hi XXXX,
Thanks for writing back with an update.
1. The MRI scan images sent by you are T2 axial and T1 sag. These show disc related problems at L 4 - L 5 and L 5 - S 1. I would have liked to view the T2 sag images also to see more clear details but if they are not available then this I can discuss based on the problem areas visible on the images sent.
2. The L 4 - L 5 disc has an annular tear postcentrally with a diffuse disc bulge.
3. The L 5 - S 1 has diffuse disc bulge with disc height narrowing and the amount of disc problem is known to cause moderate to severe pain in patients hiving such findings on MRI scan.
4. You might require something more than epidural shots if they are not working much or probably radiofrequency ablation and nerve block should help temporarily. Most treatments require repeat sessions every year.
5. Surgery might be recommended after doing a clinical examination and understanding the pain and discomfort you have but this is more of a clinical decision. Please note that in about 20 to 40 percent of lower back surgeries, the patient might continue to have the same amount of pain or even the pain can become more severe even after the surgery.
6. Therefore I would recommend the use of all medical methods before thinking in terms of surgical treatment.
Hope your query is answered.
Do write back if you have any doubts.
Regards,
Dr.Vivek
You have disc problem at L 4 - L 5 and L 5 - S 1 levels requiring attention
Detailed Answer:
Hi XXXX,
Thanks for writing back with an update.
1. The MRI scan images sent by you are T2 axial and T1 sag. These show disc related problems at L 4 - L 5 and L 5 - S 1. I would have liked to view the T2 sag images also to see more clear details but if they are not available then this I can discuss based on the problem areas visible on the images sent.
2. The L 4 - L 5 disc has an annular tear postcentrally with a diffuse disc bulge.
3. The L 5 - S 1 has diffuse disc bulge with disc height narrowing and the amount of disc problem is known to cause moderate to severe pain in patients hiving such findings on MRI scan.
4. You might require something more than epidural shots if they are not working much or probably radiofrequency ablation and nerve block should help temporarily. Most treatments require repeat sessions every year.
5. Surgery might be recommended after doing a clinical examination and understanding the pain and discomfort you have but this is more of a clinical decision. Please note that in about 20 to 40 percent of lower back surgeries, the patient might continue to have the same amount of pain or even the pain can become more severe even after the surgery.
6. Therefore I would recommend the use of all medical methods before thinking in terms of surgical treatment.
Hope your query is answered.
Do write back if you have any doubts.
Regards,
Dr.Vivek
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you for your findings , I do believe I sent the T2 sags, possibly there is a delay in them being received. I have a couple more questions, not meaning to abuse the time you already have given, but do you feel that there may be a chance by what you see of nerves being trapped? Also is there an orthopedic surgeon there that could thrown more light on what could be done. It has caused my hips to seize up, the musles around l4-s1 to become non functional, have to hobble when i walk and after a short time start to lose sensation in legs especially right one, muscles holding bladder have weakened severely as well. Thankyou again for your time.
Brief Answer:
The nerves are certainly getting trapped at the roots or along their route
Detailed Answer:
Hi XXXX,
Thanks for writing back with an update.
1. The nerves supplying your problem areas originate from nerve roots in the lower back region. A single nerve has nerve roots originating at more than one level. Therefore, trapping of nerve roots at multiple levels can further intensify the symptoms experienced.
2. A nerve also takes a fixed course from its formation till its termination into distributing branches. Nerve trapping anywhere along the route will also cause symptoms proportional to the nerve entrapment.
3. It is clear that your nerve roots are under pressure due to disc problems and this is causing the symptoms that you have.
4. There are orthopedicians at healthcaremagic.com but for an opinion specifically from the orthopedic point of view, you will have to open another new query and either select the query to be answered by an orthopedician or request the moderators to direct your query to an orthopedician. Please note that charges for certain services might vary and please confirm through an email to customer care for the exact details of payment for a specific service.
5. As this query is essentially on MRI interpretation, I was able to take up this query and reply back to you.
6. In my opinion, after going through your images in detail, if you have been through multiple conservative treatments in the last two years and still experiencing severe pain and symptoms as described then a surgical treatment by a specialist neurosurgeon might have to be discussed at your end, following complete neurological clinical examination.
Hope your query is answered.
Do write back if you have any doubts.
Regards,
Dr.Vivek
The nerves are certainly getting trapped at the roots or along their route
Detailed Answer:
Hi XXXX,
Thanks for writing back with an update.
1. The nerves supplying your problem areas originate from nerve roots in the lower back region. A single nerve has nerve roots originating at more than one level. Therefore, trapping of nerve roots at multiple levels can further intensify the symptoms experienced.
2. A nerve also takes a fixed course from its formation till its termination into distributing branches. Nerve trapping anywhere along the route will also cause symptoms proportional to the nerve entrapment.
3. It is clear that your nerve roots are under pressure due to disc problems and this is causing the symptoms that you have.
4. There are orthopedicians at healthcaremagic.com but for an opinion specifically from the orthopedic point of view, you will have to open another new query and either select the query to be answered by an orthopedician or request the moderators to direct your query to an orthopedician. Please note that charges for certain services might vary and please confirm through an email to customer care for the exact details of payment for a specific service.
5. As this query is essentially on MRI interpretation, I was able to take up this query and reply back to you.
6. In my opinion, after going through your images in detail, if you have been through multiple conservative treatments in the last two years and still experiencing severe pain and symptoms as described then a surgical treatment by a specialist neurosurgeon might have to be discussed at your end, following complete neurological clinical examination.
Hope your query is answered.
Do write back if you have any doubts.
Regards,
Dr.Vivek
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
It has. Thank you so much for all your time, I am incredibly grateful for it, and hope fate returns it in kind. Bless you.
Brief Answer:
Welcome and wish you good health
Detailed Answer:
Hi XXXX,
Welcome and thanks for sending in your query.
Should you have any more health queries in the future and would like to have it answered by me then please mention "query Id 185281 Attn Dr.Vivek Chail" in your query and the moderators will direct your query to me. I will reply back to you at the earliest.
Wish you good health.
Regards,
Dr.Vivek
Welcome and wish you good health
Detailed Answer:
Hi XXXX,
Welcome and thanks for sending in your query.
Should you have any more health queries in the future and would like to have it answered by me then please mention "query Id 185281 Attn Dr.Vivek Chail" in your query and the moderators will direct your query to me. I will reply back to you at the earliest.
Wish you good health.
Regards,
Dr.Vivek
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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